Reimbursement and Coverage

Clinical laboratories are reimbursed for providing services to Medicare beneficiaries using either the Physician Fee Schedule (PFS) or the Clinical Laboratory Fee Schedule (CLFS), depending on the nature of the service.  In addition, clinical laboratories provide services to beneficiaries of other government programs such as Medicaid, TRICARE and the Federal Employee Health Benefit Plan (FEHBP),…

Clinical laboratories are reimbursed for providing services to Medicare beneficiaries using either the Physician Fee Schedule (PFS) or the Clinical Laboratory Fee Schedule (CLFS), depending on the nature of the service.  In addition, clinical laboratories provide services to beneficiaries of other government programs such as Medicaid, TRICARE and the Federal Employee Health Benefit Plan (FEHBP), as well as commercial plans.

Lab reimbursement in many of these programs has been reduced in recent years, and in the case of the Medicare program, annual cuts are scheduled in current law not only as a result of sequestration, but also through annual cuts built into the Affordable Care Act.

While payments for lab services are being slashed, the costs associated with providing critical laboratory services - including labor, supplies, and transportation - continue to climb.

Although many labs have managed to navigate changes in markets and reimbursement and while still continually improving quality, continued arbitrary and severe payment reductions will result in reduced access to essential tests for critically ill patients, less innovation, more closures or consolidation of businesses, and more people out of jobs.

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  • Letter to HHS on ICD-10 Implementation

    March 28, 2012
    March 28, 2012 The Honorable Kathleen Sebelius Secretary Department of Health and Human Services Room 445-G Hubert H. Humphrey Building 200 Independence Avenue, S.W. Washington, DC 20201 Re: ICD-10-CM Implementation Dear Secretary Sebelius, I am writing to you on behalf of the American Clinical Laboratory Association (ACLA) to urge the Department of Health and Human Services (HHS) to adopt several important recommendations as theContinue Reading »...
  • Letter to Speaker Boehner and Majority Leader Reid Regarding Medicare Clinical Laboratory Fee Schedule

    March 06, 2012
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  • Big Cuts in Reimbursement for Medicare Lab Tests will Hurt Patients, says ACLA

    March 06, 2012
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  • Comments on Coverage with Evidence Development

    January 18, 2012
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  • Letter to Chairman Baucus and Ranking Member Hatch Regarding TC “Grandfather” Provision

    December 07, 2011
        December 7, 2011   The Honorable Max Baucus Chairman Senate Finance Committee Washington, DC 20510   The Honorable Orrin Hatch Ranking Member Senate Finance Committee Washington, DC 20510   Dear Chairman Baucus and Ranking Member Hatch:   The undersigned organizations, representing laboratories, hospitals, laboratory professionals, physicians, and the patients we serve, urge you to extend an expiring provision that would ensure hospitalsContinue Reading »...
  • Letter to Majority Leader Reid and Minority Leader McConnell Regarding SGR

    December 05, 2011
      December 5, 2011   The Honorable Harry Reid Majority Leader U.S. Senate Washington, D.C. 20510   The Honorable Mitch McConnell Minority Leader U.S. Senate Washington, D.C. 20510   Dear Majority Leader Reid and Minority Leader McConnell:   The Alliance for Integrity in Medicare (AIM), a coalition committed to ending the practice of inappropri- ate physician self-referral in Medicare, appreciates your commitment to addressContinue Reading »...
  • Letter to Chairman Upton and Ranking Member Waxman Regarding SGR

    December 05, 2011
        December 5, 2011   The Honorable Fred Upton Chairman Committee on Energy and Commerce U.S. House of Representatives Washington, D.C. 20515   The Honorable Henry Waxman Ranking Member Committee on Energy and Commerce U.S. House of Representatives Washington, D.C. 20515   Dear Chairman Upton and Ranking Member Waxman:   The Alliance for Integrity in Medicare (AIM), a coalition committed to ending theContinue Reading »...
  • Letter to Chairman Baucus and Ranking Member Hatch Regarding SGR

    December 05, 2011
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  • Letter to Chairman Camp and Ranking Member Levin Regarding SGR

    December 03, 2011
        December 5, 2011   The Honorable Dave Camp Chairman Committee on Ways and Means U.S. House of Representatives Washington, D.C. 20515   The Honorable Sander Levin Ranking Member Committee on Ways and Means U.S. House of Representatives Washington, D.C. 20515   Dear Chairman Camp and Ranking Member Levin:   The Alliance for Integrity in Medicare (AIM), a coalition committed to ending theContinue Reading »...
  • AIM Letter to Sens Murray and Hensarling Regarding IOAS Letter

    September 20, 2011
        September 20, 2011   The Honorable Patty Murray, Co-Chair, Joint Select Committee on Deficit Reduction   The Honorable Jeb Hensarling, Co-Chair, Joint Select Committee on Deficit Reduction   Dear Chairwoman Murray and Chairman Hensarling:   On behalf of the Alliance for Integrity in Medicare (AIM), a coalition committed to ending the practice of inappropriate physician self-referral in Medicare, we recognize the challengesContinue Reading »...
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